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Lee JH, Song IS, Kang P, Ji SH, Jang YE, Kim EH, Kim HS, Kim JT. Validation of the Masimo O3™ regional oximetry device in pediatric patients undergoing cardiac surgery. J Clin Monit Comput 2022; 36:1703-1709. [PMID: 35169968 DOI: 10.1007/s10877-022-00815-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
We assessed the accuracy of Masimo O3™ regional cerebral oxygen saturation (rSO2) readings by comparing them with reference values and evaluated the relationship between rSO2 and somatic tissue oxygen saturation (StO2) in children undergoing cardiac surgery. After anesthesia induction, pediatric sensors were applied to the forehead and foot sole, and rSO2 and StO2 values were monitored continuously. Before cardiopulmonary bypass (CPB), FIO2 was set to 0.2, 0.5, and 0.8 serially every 15 min. After CPB, FIO2 was reversed. The reference values (SavO2) were calculated by combining arterial (SaO2) and central venous oxygen saturation (SvO2) readings from the arterial and central lines, respectively (0.7 [Formula: see text] SvO2 + 0.3 [Formula: see text] SaO2). In total, 265 pairs of rSO2/StO2 and SavO2 from 49 patients were analyzed. The bias, standard deviation (SD), standard error (SE), and root mean squared error (RMSE) of rSO2 were 2.6%, 4.5%, 0.3%, and 4.3%, respectively. The limits of agreement ranged from -6.3% to 11.6%. Trend accuracy analysis yielded a relative mean error of -1.4%, with an SD of 4.3%, SE of 0.2%, and RMSE of 3.9%. According to multiple linear regression analysis, the application of CPB, FIO2, Hb level, and tip location of the central venous catheter influenced the bias (all P < 0.05). Furthermore, the correlation between rSO2 and StO2 was weak (r = 0.254). rSO2 readings by the Masimo O3™ device and pediatric sensor had good absolute and trending accuracies with respect to the calculated reference values in children undergoing cardiac surgery. rSO2 and StO2 cannot be used interchangeably.Clinical trial registration http://clinicaltrials.gov (number: NCT04208906).
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - In-Sun Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.
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Bailey SM, Prakash SS, Verma S, Desai P, Kazmi S, Mally PV. Near-infrared spectroscopy in the medical management of infants. Curr Probl Pediatr Adolesc Health Care 2022; 52:101291. [PMID: 36404215 DOI: 10.1016/j.cppeds.2022.101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Near-infrared spectroscopy (NIRS) is a technology that is easy to use and can provide helpful information about organ oxygenation and perfusion by measuring regional tissue oxygen saturation (rSO2) with near-infrared light. The sensors can be placed in different anatomical locations to monitor rSO2 levels in several organs. While NIRS is not without limitations, this equipment is now becoming increasingly integrated into modern healthcare practice with the goal of achieving better outcomes for patients. It can be particularly applicable in the monitoring of pediatric patients because of their size, and especially so in infant patients. Infants are ideal for NIRS monitoring as nearly all of their vital organs lie near the skin surface which near-infrared light penetrates through. In addition, infants are a difficult population to evaluate with traditional invasive monitoring techniques that normally rely on the use of larger catheters and maintaining vascular access. Pediatric clinicians can observe rSO2 values in order to gain insight about tissue perfusion, oxygenation, and the metabolic status of their patients. In this way, NIRS can be used in a non-invasive manner to either continuously or periodically check rSO2. Because of these attributes and capabilities, NIRS can be used in various pediatric inpatient settings and on a variety of patients who require monitoring. The primary objective of this review is to provide pediatric clinicians with a general understanding of how NIRS works, to discuss how it currently is being studied and employed, and how NIRS could be increasingly used in the near future, all with a focus on infant management.
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Affiliation(s)
- Sean M Bailey
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016.
| | - Shrawani Soorneela Prakash
- Division of Neonatology, Department of Pediatrics, NYCHHC/Lincoln Medical and Mental Health Center, Bronx, NY 10451
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Purnahamsi Desai
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Sadaf Kazmi
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Pradeep V Mally
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
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Afshari A, Saager RB, Burgos D, Vogt WC, Wang J, Mendoza G, Weininger S, Sung KB, Durkin AJ, Pfefer TJ. Evaluation of the robustness of cerebral oximetry to variations in skin pigmentation using a tissue-simulating phantom. BIOMEDICAL OPTICS EXPRESS 2022; 13:2909-2928. [PMID: 35774336 PMCID: PMC9203096 DOI: 10.1364/boe.454020] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 05/20/2023]
Abstract
Clinical studies have demonstrated that epidermal pigmentation level can affect cerebral oximetry measurements. To evaluate the robustness of these devices, we have developed a phantom-based test method that includes an epidermis-simulating layer with several melanin concentrations and a 3D-printed cerebrovascular module. Measurements were performed with neonatal, pediatric and adult sensors from two commercial oximeters, where neonatal probes had shorter source-detector separation distances. Referenced blood oxygenation levels ranged from 30 to 90%. Cerebral oximeter outputs exhibited a consistent decrease in saturation level with simulated melanin content; this effect was greatest at low saturation levels, producing a change of up to 15%. Dependence on pigmentation was strongest in a neonatal sensor, possibly due to its high reflectivity. Overall, our findings indicate that a modular channel-array phantom approach can provide a practical tool for assessing the impact of skin pigmentation on cerebral oximeter performance and that modifications to algorithms and/or instrumentation may be needed to mitigate pigmentation bias.
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Affiliation(s)
- Ali Afshari
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, Maryland 20993, USA
| | - Rolf B. Saager
- Linköping Univ., Dept. of Biomedical Engineering, Linköping, Sweden
| | - David Burgos
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, Maryland 20993, USA
| | - William C. Vogt
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, Maryland 20993, USA
| | - Jianting Wang
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, Maryland 20993, USA
| | - Gonzalo Mendoza
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, Maryland 20993, USA
| | - Sandy Weininger
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, Maryland 20993, USA
| | - Kung-Bin Sung
- National Taiwan University, Graduate Institute of Biomedical Electronics and Bioinformatics, Taipei, Taiwan
| | - Anthony J. Durkin
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, California 92697, USA
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, 1002 Health Sciences Rd. East Irvine, California 92617, USA
| | - T. Joshua Pfefer
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, Maryland 20993, USA
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Loomba RS, Rausa J, Sheikholeslami D, Dyson AE, Farias JS, Villarreal EG, Flores S, Bronicki RA. Correlation of Near-Infrared Spectroscopy Oximetry and Corresponding Venous Oxygen Saturations in Children with Congenital Heart Disease. Pediatr Cardiol 2022; 43:197-206. [PMID: 34459948 DOI: 10.1007/s00246-021-02718-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
Abstract
Invasive and non-invasive monitoring allow for early detection of hemodynamic compromise, facilitating timely intervention and avoidance of further decline. While venous oximetry is useful for assessing the adequacy of systemic oxygen delivery (DO2), it is most often intermittent, invasive, and costly. Near-infrared spectroscopy (NIRS) oximetry allows for the non-invasive estimation of the adequacy of DO2. We assessed the correlation between cerebral NIRS oximetry and superior vena cava (SVC) and jugular venous (JV) oxygen saturations and between renal NIRS oximetry and inferior vena cava (IVC) oxygen saturations. Systematic review of the literature was conducted to identify studies with data regarding near-infrared spectroscopy and venous saturation. The PubMed, EMBASE, Medline, and Cochrane databases were queried using the following terms in isolation and various combinations: "congenital heart disease," "near infrared spectroscopy," "venous saturation," and "pediatric." Pediatric studies in which simultaneous NIRS oximetry and corresponding venous oxygen saturations were simultaneously collected after cardiac surgery or catheterization were identified. Data were pooled from these studies to analyze the correlation between NIRS oximetry and the corresponding venous oxygen saturations. A total of 16 studies with 613 patients were included in the final analyses. Data were present to compare cerebral and renal NIRS oximetry with corresponding venous oxygen saturation. Cerebral NIRS and SVC and JV oxygen saturations and renal NIRS and IVC oxygen saturations demonstrated strong degrees of correlation (r-value 0.70 for each). However, cerebral NIRS and IVC oxygen saturation had a week degree of correlation (r-value of 0.38). Pooled analyses demonstrate that cerebral NIRS oximetry correlates strongly with SVC or JV oxygen saturation while renal NIRS oximetry correlates strongly with IVC oxygen saturations. A weak correlation was noted between cerebral NIRS oximetry and IVC oxygen saturations.
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Affiliation(s)
- Rohit S Loomba
- Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA.,Medicine, Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Jacqueline Rausa
- Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Danielle Sheikholeslami
- Medicine, Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Aaron E Dyson
- Medicine, Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
| | - Saul Flores
- Division of Critical Care, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Ronald A Bronicki
- Division of Critical Care, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
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Zhang Z, Qi M, Hügli G, Khatami R. Quantitative Changes in Muscular and Capillary Oxygen Desaturation Measured by Optical Sensors during Continuous Positive Airway Pressure Titration for Obstructive Sleep Apnea. BIOSENSORS 2021; 12:bios12010003. [PMID: 35049631 PMCID: PMC8774245 DOI: 10.3390/bios12010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/24/2021] [Accepted: 12/19/2021] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder, and continuous positive airway pressure (CPAP) is the most effective treatment. Poor adherence is one of the major challenges in CPAP therapy. The recent boom of wearable optical sensors measuring oxygen saturation makes at-home multiple-night CPAP titrations possible, which may essentially improve the adherence of CPAP therapy by optimizing its pressure in a real-life setting economically. We tested whether the oxygen desaturations (ODs) measured in the arm muscle (arm_OD) by gold-standard frequency-domain multi-distance near-infrared spectroscopy (FDMD-NIRS) change quantitatively with titrated CPAP pressures in OSA patients together with polysomnography. We found that the arm_OD (2.08 ± 1.23%, mean ± standard deviation) was significantly smaller (p-value < 0.0001) than the fingertip OD (finger_OD) (4.46 ± 2.37%) measured by a polysomnography pulse oximeter. Linear mixed-effects models suggested that CPAP pressure was a significant predictor for finger_OD but not for arm_OD. Since FDMD-NIRS measures a mixture of arterial and venous OD, whereas a fingertip pulse oximeter measures arterial OD, our results of no association between arm_OD and finger_OD indicate that the arm_OD mainly represented venous desaturation. Arm_OD measured by optical sensors used for wearables may not be a suitable indicator of the CPAP titration effectiveness.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland; (M.Q.); (G.H.); (R.K.)
- Barmelweid Academy, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland
- Correspondence:
| | - Ming Qi
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland; (M.Q.); (G.H.); (R.K.)
| | - Gordana Hügli
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland; (M.Q.); (G.H.); (R.K.)
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland; (M.Q.); (G.H.); (R.K.)
- Barmelweid Academy, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Zhang Z, Qi M, Hügli G, Khatami R. The Challenges and Pitfalls of Detecting Sleep Hypopnea Using a Wearable Optical Sensor: Comparative Study. J Med Internet Res 2021; 23:e24171. [PMID: 34326039 PMCID: PMC8367170 DOI: 10.2196/24171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/26/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is the most prevalent respiratory sleep disorder occurring in 9% to 38% of the general population. About 90% of patients with suspected OSA remain undiagnosed due to the lack of sleep laboratories or specialists and the high cost of gold-standard in-lab polysomnography diagnosis, leading to a decreased quality of life and increased health care burden in cardio- and cerebrovascular diseases. Wearable sleep trackers like smartwatches and armbands are booming, creating a hope for cost-efficient at-home OSA diagnosis and assessment of treatment (eg, continuous positive airway pressure [CPAP] therapy) effectiveness. However, such wearables are currently still not available and cannot be used to detect sleep hypopnea. Sleep hypopnea is defined by ≥30% drop in breathing and an at least 3% drop in peripheral capillary oxygen saturation (Spo2) measured at the fingertip. Whether the conventional measures of oxygen desaturation (OD) at the fingertip and at the arm or wrist are identical is essentially unknown. Objective We aimed to compare event-by-event arm OD (arm_OD) with fingertip OD (finger_OD) in sleep hypopneas during both naïve sleep and CPAP therapy. Methods Thirty patients with OSA underwent an incremental, stepwise CPAP titration protocol during all-night in-lab video-polysomnography monitoring (ie, 1-h baseline sleep without CPAP followed by stepwise increments of 1 cmH2O pressure per hour starting from 5 to 8 cmH2O depending on the individual). Arm_OD of the left biceps muscle and finger_OD of the left index fingertip in sleep hypopneas were simultaneously measured by frequency-domain near-infrared spectroscopy and video-polysomnography photoplethysmography, respectively. Bland-Altman plots were used to illustrate the agreements between arm_OD and finger_OD during baseline sleep and under CPAP. We used t tests to determine whether these measurements significantly differed. Results In total, 534 obstructive apneas and 2185 hypopneas were recorded. Of the 2185 hypopneas, 668 (30.57%) were collected during baseline sleep and 1517 (69.43%), during CPAP sleep. The mean difference between finger_OD and arm_OD was 2.86% (95% CI 2.67%-3.06%, t667=28.28; P<.001; 95% limits of agreement [LoA] –2.27%, 8.00%) during baseline sleep and 1.83% (95% CI 1.72%-1.94%, t1516=31.99; P<.001; 95% LoA –2.54%, 6.19%) during CPAP. Using the standard criterion of 3% saturation drop, arm_OD only recognized 16.32% (109/668) and 14.90% (226/1517) of hypopneas at baseline and during CPAP, respectively. Conclusions arm_OD is 2% to 3% lower than standard finger_OD in sleep hypopnea, probably because the measured arm_OD originates physiologically from arterioles, venules, and capillaries; thus, the venous blood adversely affects its value. Our findings demonstrate that the standard criterion of ≥3% OD drop at the arm or wrist is not suitable to define hypopnea because it could provide large false-negative results in diagnosing OSA and assessing CPAP treatment effectiveness.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Barmelweid, Switzerland.,Barmelweid Academy, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Ming Qi
- Center for Sleep Medicine, Sleep Research and Epileptology, Barmelweid, Switzerland
| | - Gordana Hügli
- Center for Sleep Medicine, Sleep Research and Epileptology, Barmelweid, Switzerland
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Barmelweid, Switzerland.,Barmelweid Academy, Clinic Barmelweid AG, Barmelweid, Switzerland.,Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
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Choi SH, Lee J, Nam SK, Jun YH. Cerebral Oxygenation during Apnea in Preterm Infants: Effects of Accompanying Peripheral Oxygen Desaturation. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Candan T, Candan M, Yildiz CE, Gumustas M, Erenturk S, Yalcinbas YK. Comparison of bilateral cerebral and somatic tissue oxygenation with near-infrared spectroscopy in cyanotic and acyanotic pediatric patients receiving cardiac surgery. Arch Med Sci Atheroscler Dis 2020; 5:e320-e331. [PMID: 34820545 PMCID: PMC8609373 DOI: 10.5114/amsad.2020.103377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/04/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Compromise of tissue oxygenation during surgery is associated with increased mortality and morbidity in the postoperative period in patients with congenital cardiac disorders. It may be monitored with near-infrared spectroscopy (NIRS). We aimed to evaluate the tissue oxygenation and factors which may affect it by bilateral cerebral and somatic NIRS levels during cardiopulmonary bypass and to compare the NIRS values of cyanotic and acyanotic patient groups. MATERIAL AND METHODS Two groups of patients with cyanotic and acyanotic congenital heart diseases were included in the study. Each group consisted of 15 patients between 0 and 5 years of age. All data were collected following anesthesia induction (T1), the 10th (T2) and 30th min (T3) of cardiopulmonary bypass (CPB), every 30 min during CPB (T4, T5, T6) and 1 h after (TS). Bilateral and somatic NIRS, blood gases, mean arterial pressure, and temperatures were recorded. RESULTS Left and right somatic NIRS values in groups at all measurements did not differ significantly. Left and right cerebral NIRS values at T2 and T3 in cyanotic patients were significantly higher than in acyanotic patients. Mean arterial pressure and lactate levels at T1 and T3 measurements were responsible for left cerebral NIRS changes and mean arterial pressure on right cerebral NIRS values. CONCLUSIONS Monitorization of tissue perfusion has critical importance during CPB of patients with congenital heart defects. Oxygenation may easily and reliably be measured with NIRS. Cerebral and somatic NIRS are more pronounced in cyanotic patients and cerebral NIRS is strongly associated with mean arterial pressure and circulating lactate levels.
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Affiliation(s)
- Tulay Candan
- Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muhammet Candan
- Medipol Mega University Hospital, Cardiovascular Surgery, Istanbul, Turkey
| | - Cenk Eray Yildiz
- Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehmet Gumustas
- Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selim Erenturk
- Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yusuf Kenan Yalcinbas
- Department of Cardiovascular Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
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Nitzan M, Nitzan I, Arieli Y. The Various Oximetric Techniques Used for the Evaluation of Blood Oxygenation. SENSORS 2020; 20:s20174844. [PMID: 32867184 PMCID: PMC7506757 DOI: 10.3390/s20174844] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Abstract
Adequate oxygen delivery to a tissue depends on sufficient oxygen content in arterial blood and blood flow to the tissue. Oximetry is a technique for the assessment of blood oxygenation by measurements of light transmission through the blood, which is based on the different absorption spectra of oxygenated and deoxygenated hemoglobin. Oxygen saturation in arterial blood provides information on the adequacy of respiration and is routinely measured in clinical settings, utilizing pulse oximetry. Oxygen saturation, in venous blood (SvO2) and in the entire blood in a tissue (StO2), is related to the blood supply to the tissue, and several oximetric techniques have been developed for their assessment. SvO2 can be measured non-invasively in the fingers, making use of modified pulse oximetry, and in the retina, using the modified Beer–Lambert Law. StO2 is measured in peripheral muscle and cerebral tissue by means of various modes of near infrared spectroscopy (NIRS), utilizing the relative transparency of infrared light in muscle and cerebral tissue. The primary problem of oximetry is the discrimination between absorption by hemoglobin and scattering by tissue elements in the attenuation measurement, and the various techniques developed for isolating the absorption effect are presented in the current review, with their limitations.
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Affiliation(s)
- Meir Nitzan
- Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., Jerusalem 91160, Israel;
- Correspondence:
| | - Itamar Nitzan
- Monash Newborn, Monash Children’s Hospital, Melbourne 3168, Australia;
- Department of Neonatology, Shaare Zedek Medical Center, Shmuel Bait St 12, Jerusalem 9103102, Israel
| | - Yoel Arieli
- Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., Jerusalem 91160, Israel;
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Lang SS, Khanna O, Atkin NJ, Palma JE, Yuan I, Storm PB, Heuer GG, Kennedy B, Waanders AJ, Li Y, Huh JW. Perioperative near-infrared spectroscopy cerebral oxygen saturation in symptomatic pediatric hydrocephalus patients at risk for intracranial hypertension. J Neurosurg Pediatr 2020; 25:235-241. [PMID: 31783356 DOI: 10.3171/2019.9.peds19457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The lack of a continuous, noninvasive modality for monitoring intracranial pressure (ICP) is a major obstacle in the care of pediatric patients with hydrocephalus who are at risk for intracranial hypertension. Intracranial hypertension can lead to cerebral ischemia and brain tissue hypoxia. In this study, the authors evaluated the use of near-infrared spectroscopy (NIRS) to measure regional cerebral oxygen saturation (rSO2) in symptomatic pediatric patients with hydrocephalus concerning for elevated ICP. METHODS The authors evaluated the NIRS rSO2 trends in pediatric patients presenting with acute hydrocephalus and clinical symptoms of intracranial hypertension. NIRS rSO2 values were recorded hourly before and after neurosurgical intervention. To test for significance between preoperative and postoperative values, the authors constructed a linear regression model with the rSO2 values as the outcome and pre- and postsurgery cohorts as the independent variable, adjusted for age and sex, and used the generalized estimating equation method to account for within-subject correlation. RESULTS Twenty-two pediatric patients underwent NIRS rSO2 monitoring before and after CSF diversion surgery. The mean durations of NIRS rSO2 recording pre- and postoperatively were 13.95 and 26.82 hours, respectively. The mean pre- and postoperative rSO2 values were 73.84% and 80.65%, respectively, and the adjusted mean difference estimated from the regression model was 5.98% (adjusted p < 0.0001), suggestive of improved cerebral oxygenation after definitive neurosurgical CSF diversion treatment. Postoperatively, all patients returned to baseline neurological status with no clinical symptoms of elevated ICP. CONCLUSIONS Cerebral oxygenation trends measured by NIRS in symptomatic pediatric hydrocephalus patients with intracranial hypertension generally improve after CSF diversion surgery.
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Affiliation(s)
- Shih-Shan Lang
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- 2Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
- 6Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
| | - Omaditya Khanna
- 3Department of Neurological Surgery, Thomas Jefferson University Hospital
| | - Natalie J Atkin
- 4Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
- 5Department of Anesthesia, Perelman School of Medicine, University of Pennsylvania
| | - Judy E Palma
- 6Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
| | - Ian Yuan
- 4Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
- 5Department of Anesthesia, Perelman School of Medicine, University of Pennsylvania
| | - Phillip B Storm
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- 2Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
- 6Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
| | - Gregory G Heuer
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- 2Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
- 6Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
| | - Benjamin Kennedy
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- 2Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania
- 6Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
| | - Angela J Waanders
- 6Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
- 10Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yimei Li
- 7Department of Oncology, Children's Hospital of Philadelphia
- 8Department of Oncology, Perelman School of Medicine, University of Pennsylvania
- 9Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Jimmy W Huh
- 4Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
- 5Department of Anesthesia, Perelman School of Medicine, University of Pennsylvania
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11
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Zaleski KL, Kussman BD. Near-Infrared Spectroscopy in Pediatric Congenital Heart Disease. J Cardiothorac Vasc Anesth 2019; 34:489-500. [PMID: 31582201 DOI: 10.1053/j.jvca.2019.08.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 08/07/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Abstract
Near-infrared spectroscopy (NIRS) is widely used to monitor tissue oxygenation in the pediatric cardiac surgical population. Clinicians who use NIRS must understand the underlying measurement principles in order to interpret and use this monitoring modality appropriately. The aims of this narrative review are to provide a brief overview of NIRS technology, discuss the normative and critical values of cerebral and somatic tissue oxygen saturation and the interpretation of these values, present the clinical studies (and their limitations) of NIRS as a perioperative monitoring modality in the pediatric congenital heart disease population, and introduce the emerging and future applications of NIRS.
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Affiliation(s)
- Katherine L Zaleski
- Department of Anesthesiology, Perioperative, and Critical Care Medicine, Division of Cardiac Anesthesia, Boston Children's Hospital, Boston, MA.
| | - Barry D Kussman
- Department of Anesthesiology, Perioperative, and Critical Care Medicine, Division of Cardiac Anesthesia, Boston Children's Hospital, Boston, MA
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Afshari A, Ghassemi P, Lin J, Halprin M, Wang J, Mendoza G, Weininger S, Pfefer TJ. Cerebral oximetry performance testing with a 3D-printed vascular array phantom. BIOMEDICAL OPTICS EXPRESS 2019; 10:3731-3746. [PMID: 31452971 PMCID: PMC6701524 DOI: 10.1364/boe.10.003731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 05/13/2023]
Abstract
Cerebral oximetry based on near-infrared spectroscopy represents a unique noninvasive tool for real-time surgical monitoring, yet studies have shown a significant discrepancy in accuracy among commercial systems. Towards the establishment of a standardized method for performance testing, we have studied a solid phantom approach - based on a 3D-printed cerebrovascular module (CVM) incorporating an array of 148 cylindrical channels - that has several advantages over liquid phantoms. Development and characterization of a CVM prototype are described, including high-resolution imaging and spectrophotometry measurements. The CVM was filled with whole bovine blood tuned over an oxygen saturation range of 30-90% and molded-silicone layers simulating extracerebral tissues were used to evaluate penetration depth. Saturation measurement accuracy was assessed in two commercially-available clinical cerebral oximeters. For one oximeter, both neonatal and pediatric sensors showed a high degree of precision, whereas accuracy was strongly dependent on saturation level and extracerebral geometry. The second oximeter showed worse precision, yet greater robustness to variations in extracerebral layers. These results indicate that 3D-printed channel array phantoms represent a promising new approach for standardized testing of clinical oximeters.
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Nasr VG, Bergersen LT, Lin HM, Benni PB, Bernier RS, Anderson ME, Kussman BD. Validation of a Second-Generation Near-Infrared Spectroscopy Monitor in Children With Congenital Heart Disease. Anesth Analg 2019; 128:661-668. [DOI: 10.1213/ane.0000000000002796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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la Cour A, Greisen G, Hyttel-Sorensen S. In vivo validation of cerebral near-infrared spectroscopy: a review. NEUROPHOTONICS 2018; 5:040901. [PMID: 30525059 PMCID: PMC6257082 DOI: 10.1117/1.nph.5.4.040901] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/29/2018] [Indexed: 05/24/2023]
Abstract
We summarize the available in vivo validation of cerebral near-infrared spectroscopy (NIRS) oximetry to inform future in vivo validation strategies. In particular, to establish a way forward in the assessment of NIRS instrumentation for future randomized trials, a systematic literature search is performed. The records are screened and abstracts are assessed to select studies fulfilling our inclusion criteria. Twenty-two pediatric and 28 adult studies are analyzed after exclusion of three articles in each group. All studies compare regional cerebral tissue oxygenation measured by cerebral NIRS to invasive measurement of central or jugular venous oxygen saturation. In studies without Bland-Altman plots, we extracted data from scatter plots enabling estimation of mean difference (MD), standard deviation (SD), and limits of agreement (LOA). To assess the agreement between rStO 2 (regional cerebral tissue oxygenation) estimated by NIRS and by blood samples, weighted averages of the MDs and SDs from each study are calculated. We found a fair agreement between the overall mean of cerebral tissue oxygenation and the mean of a reference value measured by co-oximetry whatever NIRS instrument or site of blood sampling used. Cerebral oxygenation overestimates the reference at low values, some instruments apparently more than others. Thus, a high degree of scatter and a lack of a good reference method complicate in vivo validation of NIRS. It is difficult to draw any firm conclusions despite the large number of studies, and the result of this review leaves us questioning if more of such validation studies of cerebral NIRS oximetry are really needed. Furthermore, the combination of lack of validation and poor repeatability is an important issue when designing a randomized clinical trial of implementing cerebral NIRS oximetry into clinical care.
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Affiliation(s)
- Amalie la Cour
- Hospital South West Jutland, Department of Children, Esbjerg, Denmark
| | - Gorm Greisen
- National University Hospital, Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Simon Hyttel-Sorensen
- National University Hospital, Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
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15
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Hunter CL, Oei JL, Suzuki K, Lui K, Schindler T. Patterns of use of near-infrared spectroscopy in neonatal intensive care units: international usage survey. Acta Paediatr 2018; 107:1198-1204. [PMID: 29430749 DOI: 10.1111/apa.14271] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 11/26/2022]
Abstract
AIM To assess uptake and applications of near-infrared spectroscopy (NIRS) by neonatal intensive care units (NICUs). METHODS A pre-piloted online questionnaire was distributed in May 2015 to 12 perinatal societies in Asia, Europe, Australasia, North America and Middle East for dissemination to NICUs. Questions surveyed demographics, NIRS research/clinical applications, usage frequency, training approaches and target infant populations. RESULTS In total, 255 responses from 235 NICUs were obtained. Of these, 85 (36%) owned a NIRS device. Australian and New Zealand NICUs were more likely to own NIRS technology than Asian (OR 1.12, 95% CI: 0.38-3.37) and North American (OR 2.63, 95% CI: 1.07-6.45) NICUs. A total of 69 (71%) used NIRS within clinical or mixed clinical-research settings, however routine reliance for management and prognostication was low (9% and 3%, respectively). Of those without NIRS technology, 96 (64%) had no acquisition intentions. The main limiting factors were controversial evidence on efficacy (59%) and financial considerations (50%). About 51% of respondents received in-house NIRS training and 32% had access to written guidelines. CONCLUSION There is considerable geographical variation in NIRS usage in NICUs that is, on the whole, limited by consumer perception of lack of evidence for its clinical utility. This knowledge gap should be addressed by future research.
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Affiliation(s)
- Carol Lu Hunter
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Kensington NSW Australia
| | - Ju Lee Oei
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Kensington NSW Australia
| | - Keiji Suzuki
- Department of Paediatrics; Tokai University School of Medicine; Isehara Japan
| | - Kei Lui
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Kensington NSW Australia
| | - Timothy Schindler
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Kensington NSW Australia
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Kleiser S, Ostojic D, Andresen B, Nasseri N, Isler H, Scholkmann F, Karen T, Greisen G, Wolf M. Comparison of tissue oximeters on a liquid phantom with adjustable optical properties: an extension. BIOMEDICAL OPTICS EXPRESS 2018; 9:86-101. [PMID: 29359089 PMCID: PMC5772591 DOI: 10.1364/boe.9.000086] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/14/2017] [Accepted: 11/19/2017] [Indexed: 05/02/2023]
Abstract
Cerebral near-infrared spectroscopy (NIRS) oximetry may help clinicians to improve patient treatment. However, the application of NIRS oximeters is increasingly causing confusion to the users due to the inconsistency of tissue oxygen haemoglobin saturation (StO2) readings provided by different oximeters. To establish a comparability of oximeters, in our study we performed simultaneous measurements on the liquid phantom mimicking properties of neonatal heads and compared the tested device to a reference NIRS oximeter (OxiplexTS). We evaluated the NIRS oximeters FORE-SIGHT, NIRO and SenSmart, and reproduced previous results with the INVOS and OxyPrem v1.3 oximeters. In general, linear relationships of the StO2 values with respect to the reference were obtained. Device specific hypoxic and hyperoxic thresholds (as used in the SafeBoosC study, www.safeboosc.eu) and a table allowing for conversion of StO2 values are provided.
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Affiliation(s)
- S. Kleiser
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
| | - D. Ostojic
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
| | - B. Andresen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
| | - N. Nasseri
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
- Institute of Complementary Medicine, University of Bern, Bern,
Switzerland
| | - H. Isler
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
| | - F. Scholkmann
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
- Institute of Complementary Medicine, University of Bern, Bern,
Switzerland
| | - T. Karen
- Department of Neonatology, University Hospital Zurich, Zurich,
Switzerland
| | - G. Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
| | - M. Wolf
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
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Urlesberger B, Pichler G. Cerebral oxygenation measured by near-infrared spectroscopy correlates with arterial oxygenation only poorly in preterm infants - a strength of that technology? Acta Paediatr 2018; 107:174. [PMID: 28856710 DOI: 10.1111/apa.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Berndt Urlesberger
- Research Unit for Cerebral Development and Oximetry Research; Medical Univerity of Graz; Graz Austria
- Research Unit for Neonatal Micro- and Macrocirculation; Medical Univerity of Graz; Graz Austria
- Division of Neonatology; Department of Paediatrics and Adolescent Medicine; Medical University of Graz; Graz Austria
| | - Gerhard Pichler
- Research Unit for Cerebral Development and Oximetry Research; Medical Univerity of Graz; Graz Austria
- Research Unit for Neonatal Micro- and Macrocirculation; Medical Univerity of Graz; Graz Austria
- Division of Neonatology; Department of Paediatrics and Adolescent Medicine; Medical University of Graz; Graz Austria
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18
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An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia. Anesthesiology 2017; 128:85-96. [PMID: 29019815 DOI: 10.1097/aln.0000000000001920] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND General anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia-ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia in infants. METHODS This multicenter study enrolled 453 infants aged less than 6 months having general anesthesia for 30 min or more. Regional cerebral oxygenation was measured by near-infrared spectroscopy. We defined events (more than 3 min) for low cerebral oxygenation as mild (60 to 69% or 11 to 20% below baseline), moderate (50 to 59% or 21 to 30% below baseline), or severe (less than 50% or more than 30% below baseline); for low mean arterial pressure as mild (36 to 45 mmHg), moderate (26 to 35 mmHg), or severe (less than 25 mmHg); and low pulse oximetry saturation as mild (80 to 89%), moderate (70 to 79%), or severe (less than 70%). RESULTS The incidences of mild, moderate, and severe low cerebral oxygenation were 43%, 11%, and 2%, respectively; mild, moderate, and severe low mean arterial pressure were 62%, 36%, and 13%, respectively; and mild, moderate, and severe low arterial saturation were 15%, 4%, and 2%, respectively. Severe low oxygen saturation measured by pulse oximetry was associated with mild and moderate cerebral desaturation; American Society of Anesthesiology Physical Status III or IV versus I was associated with moderate cerebral desaturation. Severe low cerebral saturation events were too infrequent to analyze. CONCLUSIONS Mild and moderate low cerebral saturation occurred frequently, whereas severe low cerebral saturation was uncommon. Low mean arterial pressure was common and not well associated with low cerebral saturation. Unrecognized severe desaturation lasting 3 min or longer in infants seems unlikely to explain the subsequent development of neurocognitive abnormalities.
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19
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Kussman BD, Laussen PC, Benni PB, McGowan FX, McElhinney DB. Cerebral Oxygen Saturation in Children With Congenital Heart Disease and Chronic Hypoxemia. Anesth Analg 2017; 125:234-240. [PMID: 28514318 DOI: 10.1213/ane.0000000000002073] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Increased hemoglobin (Hb) concentration accompanying hypoxemia is a compensatory response to maintain tissue oxygen delivery. Near infrared spectroscopy (NIRS) is used clinically to detect abnormalities in the balance of cerebral tissue oxygen delivery and consumption, including in children with congenital heart disease (CHD). Although NIRS-measured cerebral tissue O2 saturation (ScO2) correlates with arterial oxygen saturation (SaO2), jugular bulb O2 saturation (SjbO2), and Hb, little data exist on the interplay between these factors and cerebral O2 extraction (COE). This study investigated the associations of ScO2 and ΔSaO2-ScO2 with SaO2 and Hb and verified the normal range of ScO2 in children with CHD. METHODS Children undergoing cardiac catheterization for CHD were enrolled in a calibration and validation study of the FORE-SIGHT NIRS monitor. Two pairs of simultaneous arterial and jugular bulb samples were drawn for co-oximetry, calculation of a reference ScO2 (REF CX), and estimation of COE. Pearson correlation and linear regression were used to determine relationships between O2 saturation parameters and Hb. Data were also analyzed according to diagnostic group defined as acyanotic (SaO2 ≥ 90%) and cyanotic (SaO2 < 90%). RESULTS Of 65 children studied, acceptable jugular bulb samples (SjbO2 absolute difference between samples ≤10%) were obtained in 57 (88%). The ΔSaO2-SjbO2, ΔSaO2-ScO2, and ΔSaO2-REF CX were positively correlated with SaO2 and negatively correlated with Hb (all P < .001). Although by diagnostic group ScO2 differed statistically (P = .002), values in the cyanotic patients were within the range considered normal (69% ± 6%). COE estimated by the difference between arterial and jugular bulb O2 content (ΔCaO2-CjbO2, mL O2/100 mL) was not different for cyanotic and acyanotic patients (P = .10), but estimates using ΔSaO2-SjbO2, ΔSaO2-ScO2, or ΔSaO2-ScO2/SaO2 were significantly different between the cyanotic and acyanotic children (P < .001). CONCLUSIONS Children with adequately compensated chronic hypoxemia appear to have ScO2 values within the normal range. The ΔSaO2-ScO2 is inversely related to Hb, with the implication that in the presence of reduced Hb, particularly if coupled with a decreased cardiac output, the ScO2 can fall to values associated with brain injury in laboratory studies.
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Affiliation(s)
- Barry D Kussman
- From the *Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; †Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; ‡CAS Medical Systems Inc, Branford, Connecticut; §Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and ‖Department of Cardiothoracic Surgery, Stanford Medical Center, Palo Alto, California
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20
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Hunter CL, Oei JL, Lui K, Schindler T. Cerebral oxygenation as measured by near-infrared spectroscopy in neonatal intensive care: correlation with arterial oxygenation. Acta Paediatr 2017; 106:1073-1078. [PMID: 28349556 DOI: 10.1111/apa.13848] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/11/2017] [Accepted: 03/23/2017] [Indexed: 12/01/2022]
Abstract
AIM To assess correlation between cerebral oxygenation (rScO2 ), as measured by near-infrared spectroscopy (NIRS), and arterial oxygenation (PaO2 ), as measured by arterial blood gases, in preterm neonates. METHODS Preterm neonates <37 weeks gestation with an indwelling arterial vascular catheter were recruited between April and August 2015 from the neonatal intensive care unit of the Royal Hospital for Women, Randwick NSW, Australia. The NIRS sensor was placed on the frontolateral aspect of the head prior to arterial gas sampling. NIRS, blood gas and clinical observation data were analysed using mixed linear modelling. RESULTS Twenty-two neonates between 24 and 31 weeks gestation (mean 27.6 weeks) were recruited, and 75 readings obtained. No significant correlation was identified between cerebral oxygenation (rScO2 ) and arterial oxygenation (PaO2 ) (p = 0.37). There was also no significant correlation between rScO2 and clinically relevant parameters of SaO2 (p = 0.06), SpO2 (p = 0.44) and PaCO2 (p = 0.79). CONCLUSION This study did not demonstrate any correlation between NIRS values and arterial oxygenation in clinically stable preterm infants. These results highlight some of the difficulties in clinical interpretation of NIRS values in neonatal intensive care, and further evaluation is needed to determine the applicability of NIRS to management of preterm infants.
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Affiliation(s)
- Carol Lu Hunter
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Kensington NSW Australia
| | - Ju Lee Oei
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Kensington NSW Australia
| | - Kei Lui
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Kensington NSW Australia
| | - Timothy Schindler
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Kensington NSW Australia
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Benni PB, MacLeod D, Ikeda K, Lin HM. A validation method for near-infrared spectroscopy based tissue oximeters for cerebral and somatic tissue oxygen saturation measurements. J Clin Monit Comput 2017; 32:269-284. [PMID: 28374103 PMCID: PMC5838152 DOI: 10.1007/s10877-017-0015-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/23/2017] [Indexed: 12/19/2022]
Abstract
We describe the validation methodology for the NIRS based FORE-SIGHT ELITE® (CAS Medical Systems, Inc., Branford, CT, USA) tissue oximeter for cerebral and somatic tissue oxygen saturation (StO2) measurements for adult subjects submitted to the United States Food and Drug Administration (FDA) to obtain clearance for clinical use. This validation methodology evolved from a history of NIRS validations in the literature and FDA recommended use of Deming regression and bootstrapping statistical validation methods. For cerebral validation, forehead cerebral StO2 measurements were compared to a weighted 70:30 reference (REF CXB) of co-oximeter internal jugular venous and arterial blood saturation of healthy adult subjects during a controlled hypoxia sequence, with a sensor placed on the forehead. For somatic validation, somatic StO2 measurements were compared to a weighted 70:30 reference (REF CXS) of co-oximetry central venous and arterial saturation values following a similar protocol, with sensors place on the flank, quadriceps muscle, and calf muscle. With informed consent, 25 subjects successfully completed the cerebral validation study. The bias and precision (1 SD) of cerebral StO2 compared to REF CXB was −0.14 ± 3.07%. With informed consent, 24 subjects successfully completed the somatic validation study. The bias and precision of somatic StO2 compared to REF CXS was 0.04 ± 4.22% from the average of flank, quadriceps, and calf StO2 measurements to best represent the global whole body REF CXS. The NIRS validation methods presented potentially provide a reliable means to test NIRS monitors and qualify them for clinical use.
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Affiliation(s)
- Paul B Benni
- CAS Medical Systems (CASMED), Inc., Branford, CT, USA.
| | - David MacLeod
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Keita Ikeda
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Hung-Mo Lin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sei K, Fujita M, Okawa S, Hirasawa T, Kushibiki T, Sasa H, Furuya K, Ishihara M. Appropriate timing of blood sampling for blood gas analysis in the ventilated rabbit. J Surg Res 2016; 206:325-336. [DOI: 10.1016/j.jss.2016.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/20/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Kleiser S, Nasseri N, Andresen B, Greisen G, Wolf M. Comparison of tissue oximeters on a liquid phantom with adjustable optical properties. BIOMEDICAL OPTICS EXPRESS 2016; 7:2973-92. [PMID: 27570691 PMCID: PMC4986807 DOI: 10.1364/boe.7.002973] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 05/18/2023]
Abstract
The SafeBoosC trial showed that cerebral oximetry combined with a treatment guideline can reduce the the burden of hypoxia in neonates by 50% [Brit. Med. J.350, g7635 (2015)]. However, guidelines based on oximetry by one oximeter are not directly usable by other oximeters. We made a blood-lipid phantom simulating the neonatal head to determine the relation between oxygenation values obtained by different oximeters. We calculated coefficients for easy conversion from one oximeter to the other. We additionally determined the corresponding SafeBoosC intervention thresholds at which we measured an uncertainty of up to 9.2% when varying hemoglobin content from 25μM to 70μM. In conclusion, this paper makes the comparison of absolute values obtained by different oximeters possible.
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Affiliation(s)
- S. Kleiser
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich,
Switzerland
- equal contribution
| | - N. Nasseri
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich,
Switzerland
- equal contribution
| | - B. Andresen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
| | - G. Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
| | - M. Wolf
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich,
Switzerland
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A Cross-Sectional Survey of Near-Infrared Spectroscopy Use in Pediatric Cardiac ICUs in the United Kingdom, Ireland, Italy, and Germany. Pediatr Crit Care Med 2016; 17:36-44. [PMID: 26509814 DOI: 10.1097/pcc.0000000000000564] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Despite the increasing use of near-infrared spectroscopy across pediatric cardiac ICUs, there is significant variability and equipoise with no universally accepted management algorithms. We aimed to explore the use of near-infrared spectroscopy in pediatric cardiac ICUs in the United Kingdom, Ireland, Italy, and Germany. DESIGN A cross-sectional multicenter, multinational electronic survey of one consultant in each pediatric cardiac ICU. SETTING Pediatric cardiac ICUs in the United Kingdom and Ireland (n = 13), Italy (n = 12), and Germany (n = 33). INTERVENTIONS Questionnaire targeted to establish use, targets, protocols/thresholds for intervention, and perceived usefulness of near-infrared spectroscopy monitoring. RESULTS Overall, 42 of 58 pediatric cardiac ICUs (72%) responded: United Kingdom and Ireland, 11 of 13 (84.6%); Italy, 12 of 12 (100%); and Germany, 19 of 33 (57%, included all major centers). Near-infrared spectroscopy usage varied with 35% (15/42) reporting that near-infrared spectroscopy was not used at all (7/42) or occasionally (8/42); near-infrared spectroscopy use was much less common in the United Kingdom (46%) when compared with 78% in Germany and all (100%) in Italy. Only four units had a near-infrared spectroscopy protocol, and 18 specifically used near-infrared spectroscopy in high-risk patients; 37 respondents believed that near-infrared spectroscopy added value to standard monitoring and 23 believed that it gave an earlier indication of deterioration, but only 19 would respond based on near-infrared spectroscopy data alone. Targets for absolute values and critical thresholds for intervention varied widely between units. The reasons cited for not or occasionally using near-infrared spectroscopy were expense (n = 6), limited evidence and uncertainty on how it guides management (n = 4), difficulty in interpretation, and unreliability of data (n = 3). Amongst the regular or occasional near-infrared spectroscopy users (n = 35), 28 (66%) agreed that a multicenter study is warranted to ascertain its use. CONCLUSIONS Although most responding units used near-infrared spectroscopy for high-risk patients, the majority (31/35 [88%]) did not have any protocols or guidelines for intervention. Target thresholds and intervention algorithms are needed to support the use of near-infrared spectroscopy in pediatric cardiac ICUs; an international multicenter study is warranted.
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25
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Yu Y, Lu Y, Meng L, Han R. Monitoring cerebral ischemia using cerebral oximetry: pros and cons. J Biomed Res 2015; 30:1-4. [PMID: 26679787 PMCID: PMC4726828 DOI: 10.7555/jbr.30.20150096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/20/2015] [Accepted: 09/10/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yun Yu
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China
| | - Yi Lu
- School of Medicine, University of California San Francisco, San Francisco, California 94143, USA
| | - Lingzhong Meng
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California 94143, USA
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China.
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Ikeda K, MacLeod DB, Grocott HP, Moretti EW, Ames W, Vacchiano C. The accuracy of a near-infrared spectroscopy cerebral oximetry device and its potential value for estimating jugular venous oxygen saturation. Anesth Analg 2015; 119:1381-92. [PMID: 25313967 DOI: 10.1213/ane.0000000000000463] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND An intriguing potential clinical use of cerebral oximeter measurements (SctO2) is the ability to noninvasively estimate jugular bulb venous oxygen saturation (SjvO2). Our purpose in this study was to determine the accuracy of the FORE-SIGHT(®) (CAS Medical Systems, Branford, CT), which is calibrated to a weighted average of 70% (SjvO2) and 30% arterial saturation, for Food and Drug Administration pre-market approval 510(k) certification by adapting an industry standard protocol, ISO 9919:2005 (www.ISO.org) (used for pulse oximeters), and to evaluate the use of SctO2 and SpO2 measurements to noninvasively estimate jugular venous oxygen saturation (SnvO2). METHODS Paired blood gas samples from the radial artery and the jugular venous bulb were collected from 20 healthy volunteers undergoing progressive oxygen desaturation from 100% to 70%. The blood sample pairs were analyzed via co-oximetry and used to calculate the approximate mixed vascular cerebral blood oxygen saturation, or reference SctO2 values (refSctO2), during increasing hypoxia. These reference values were compared to bilateral FORE-SIGHT SctO2 values recorded simultaneously with the blood gas draws to determine its accuracy. Bilateral SctO2 and SpO2 measurements were then used to calculate SnvO2 values which were compared to SjvO2. RESULTS Two hundred forty-six arterial and 253 venous samples from 18 subjects were used in the analysis. The ipsilateral FORE-SIGHT SctO2 values showed a tolerance interval (TI) of [-10.72 to 10.90] and Lin concordance correlation coefficient (CCC) with standard error (SE) of 0.83 ± 0.073 with the refSctO2 values calculated using arterial and venous blood gases. The ipsilateral data had a CCC of 0.81 + 0.059 with TI of [-9.22 to 9.40] with overall bias of 0.09%, and amplitude of the root mean square of error after it was corrected with random effects analysis was 2.92%. The bias and variability values between the ipsilateral and the contralateral FORE-SIGHT SctO2 measurements varied from person to person. The SnvO2 calculated from the ipsilateral SctO2 and SpO2 data showed a CCC ± SE of 0.79 ± 0.088, TI = [-14.93 to 15.33], slope of 0.98, y-intercept of 1.14% with SjvO2 values with a bias of 0.20% and an Arms of 4.08%. The SnvO2 values calculated independently from contralateral forehead FORE-SIGHT SctO2 values were not as correlated with the SjvO2 values (contralateral side CCC + SE = 0.72 ± 0.118, TI = [-14.86 to 15.20], slope of 0.66, and y-intercept of 20.36%). CONCLUSIONS The FORE-SIGHT cerebral oximeter was able to estimate oxygen saturation within the tissues of the frontal lobe under conditions of normocapnia and varying degrees of hypoxia (with 95% confidence interval of [-5.60 to 5.78] with ipsilateral blood sample data). These findings from healthy volunteers also suggest that the use of the calculated SnvO2 derived from SctO2 and SpO2 values may be a reasonable noninvasive method of estimating SjvO2 and therefore global cerebral oxygen consumption in the clinical setting. Further laboratory and clinical research is required to define the clinical utility of near-infrared spectroscopy determination of SctO2 and SnvO2 in the operating room setting.
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Affiliation(s)
- Keita Ikeda
- From the *Department of Anesthesia, Duke University Medical Center, Durham, North Carolina; †Department of Anesthesia & Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; and ‡School of Nursing, Duke University, Durham, North Carolina
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Tweddell JS, Ghanayem NS, Hoffman GM. All this monitoring…what's necessary, what's not? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17:81-90. [PMID: 24725722 DOI: 10.1053/j.pcsu.2014.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of perioperative monitoring is to aid the clinician in optimizing care to achieve the best possible survival with the lowest possible morbidity. Ideally, we would like to have monitoring that can rapidly and accurately identify perturbations in circulatory well-being that would permit timely intervention and allow for restoration before the patient is damaged. The evidence to support the use of our standard monitoring strategies (continuous electrocardiography, blood pressure, central venous pressure, oxygen saturation and capnography) is based on expert opinion, case series, or at best observational studies. While these monitoring parameters will identify life-threatening events, they provide no direct information concerning the oxygen economy of the patient. Nevertheless, they are mandated by professional societies representing specialists in cardiac disease, critical care, and anesthesiology. Additional non-routine monitoring strategies that provide data concerning the body's oxygen economy, such as venous saturation monitoring and near infrared spectroscopy, have shown promise in prospective observational studies in managing these complex groups of patients. Ideally, high-level evidence would be required before adopting these newer strategies, but in the absence of new funding sources and the challenges of the wide variation in practice patterns between centers, this seems unlikely. The evidence supporting the current standard perioperative monitoring strategies will be reviewed. In addition, evidence supporting non-routine monitoring strategies will be reviewed and their potential for added benefit assessed.
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Affiliation(s)
- James S Tweddell
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Surgery, Division of Cardiothoracic Surgery, Milwaukee, WI.
| | - Nancy S Ghanayem
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Pediatrics, Section of Critical Care, Milwaukee, WI
| | - George M Hoffman
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Anesthesiology, The Medical College of Wisconsin, Milwaukee, WI
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Schneider A, Minnich B, Hofstätter E, Weisser C, Hattinger-Jürgenssen E, Wald M. Comparison of four near-infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants. Acta Paediatr 2014; 103:934-8. [PMID: 24847771 DOI: 10.1111/apa.12698] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/18/2014] [Accepted: 05/16/2014] [Indexed: 11/29/2022]
Abstract
AIM Measuring cerebral oxygenation using near-infrared spectroscopy (NIRS) has taken on an increasingly important role in the field of neonatology. Several companies have already developed commercial devices, and more publications are reporting absolute boundary values or percentiles for neonates. We compared four commercially used devices to discover whether they provided consistent results in the same patients. METHODS We recruited nine preterm infants and tested them for 2 h, using sensors from two different devices. The measurements were carried out six times on each child, so that all four devices were compared with each other. A total of 54 measurements were conducted. The following devices were compared: the NIRO 200 (Hamamatsu Photonics K.K), the INVOS 5100c (Somanetics), the Fore-Sight (CAS Med.) and the SenSmart X-100 (NONIN). RESULTS The cerebral tissue oxygenation data yielded by the individual devices differed significantly from each other, ranging from a minimum difference of 2.93% to a maximum difference of 12.66%. CONCLUSION The commercially available NIRS devices showed highly significant differences in local cerebral tissue oxygenation levels, to the extent that the industry cannot agree on uniform and reproducible standards. Therefore, NIRS should only be used for trend measurements in preterm infants.
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Affiliation(s)
- Anna Schneider
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - Bernd Minnich
- Division of Animal Structure & Function; Department of Cell Biology; University of Salzburg; Salzburg Austria
| | - Edda Hofstätter
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - Christof Weisser
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - Erna Hattinger-Jürgenssen
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - Martin Wald
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
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Kane I, Abramo T, Meredith M, Williams A, Crossman K, Wang W, Chandrasekhar R. Cerebral oxygen saturation monitoring in pediatric altered mental status patients. Am J Emerg Med 2014; 32:356-62. [DOI: 10.1016/j.ajem.2013.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022] Open
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Abstract
Congenital cardiac anesthesiology is a young and rapidly growing subspecialty. It embraces a large spectrum of congenital and acquired heart diseases, which now affect the entire life span of patients from “cradle to grave.” One of the challenges faced by congenital cardiac anesthesiologists is reading the large amount of relevant literature from the fields of cardiology, cardiac surgery, intensive care medicine, and anesthesiology. This review highlights some of the current themes in the literature during the past year.
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Affiliation(s)
- Richard J. Ing
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Denver, Aurora, CO, USA
| | - Mark D. Twite
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Denver, Aurora, CO, USA
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Scott JP, Hoffman GM. Near-infrared spectroscopy: exposing the dark (venous) side of the circulation. Paediatr Anaesth 2014; 24:74-88. [PMID: 24267637 DOI: 10.1111/pan.12301] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/28/2022]
Abstract
The safety of anesthesia has improved greatly in the past three decades. Standard perioperative monitoring, including pulse oximetry, has practically eliminated unrecognized arterial hypoxia as a cause for perioperative injury. However, most anesthesia-related cardiac arrests in children are now cardiovascular in origin, and standard monitoring is unable to detect many circulatory abnormalities. Near-infrared spectroscopy provides noninvasive continuous access to the venous side of regional circulations that can approximate organ-specific and global measures to facilitate the detection of circulatory abnormalities and drive goal-directed interventions to reduce end-organ ischemic injury.
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Affiliation(s)
- John P Scott
- Departments of Anesthesiology and Pediatrics, Medical College of Wisconsin, Pediatric Anesthesiology and Critical Care Medicine, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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